Deep Nerve Research Articles

Nerve distribution in myocardium including the atrial and ventricular septa in late stage human fetuses.

Few information had been reported on deep intracardiac nerves in the myocardium of late human fetuses such as nerves at the atrial-pulmonary vein junction and in the atrial and ventricular septa. We examined histological sections of the heart obtained from 12 human fetuses at 25–33 weeks. A high density of intracardiac nerves was evident around the mitral valve annulus in contrast to few nerves around the tricuspid annulus. To the crux at the atrioventricular sulcus, the degenerating left common cardinal vein brought abundant nerve bundles coming from cardiac nerves descending along the anterior aspect of the pulmonary trunk. Likewise, nerve bundles in the left atrial nerve fold came from cardiac nerves between the ascending aorta and pulmonary artery. Conversely, another nerves from the venous pole to the atrium seemed to be much limited in number. Moreover, the primary atrial septum contained much fewer nerves than the secondary septum. Therefore, nerve density in the atrial wall varied considerably between sites. As ventricular muscles were degenerated from the luminal side for sculpturing of papillary muscles and trabeculae, deep nerves became exposed to the ventricular endothelium. Likewise, as pectineal muscles were sculptured, nerves were exposed in the atrial endothelium. Consequently, a myocardial assembly or sculpture seemed to be associated with degeneration and reconstruction of early-developed nerves. A failure in reconstruction during further expansion of the left atrium might be connected with an individual variation in anatomical substrates of atrial fibrillation.

The 1470 radial endovenous laser ablation of the great saphenous vein larger than 12 mm: is it a good option? A single-center experience

Introduction Endovenous ablation of varicose veins has been used to treat varicose veins and has gained popularity as one of the preferred techniques to treat axial reflux. Initially the diameter recommended was less than 8 mm, then gradually surgeons starting gaining the experience to treat larger veins. Treating larger veins has been on the controversial side with some surgeons recommending surgery versus others recommending endovenous ablation. Patients and methods The patients were divided to three groups according to the great saphenous vein diameter and follow-up duplex arranged at 3, 6, and 2 months. Visual analog scale was used at 1 week and 4 weeks to assess postoperative pain. Results In our study, there was no incidence of deep venous thrombosis (DVT) or nerve injury in any of our groups. At 1 month, there was significant difference between the groups, but at 4 weeks there was no significant difference regarding postoperative pain. There was no recanalization with an occlusion percentage of 100% in the 3-month duplex scan in all the groups. There is no significant statistical difference between the groups regarding recanalization at 6 and 12 months. Conclusion Our study showed good short-term results of endovenous laser therapy in the ablation of large-diameter great saphenous vein. The use of endovenous laser therapy has to be a dynamic process where you as an endovascular surgeon can change a variety of parameters to optimize the final results of the procedure.

Left Femoral Artery Occlusion due to Neglected Closed Fracture Distal Femur: A Case Report

Background: Distal femur fractures must always be considered for vascular disorders given the high risk. The incidence rate of femoral fractures is 1/10000 patients per year with the incidence rate of vascular injury around 0.10% -2.00%. Salter-Harris (SH) fracture classification is used in cases of fractures involving the growth plate (physeal plate) in children. Volkmann's ischemic contracture is caused by severe injury to the deep tissue and nerves. If tissue pressure is equal to or more than the perfusion pressure of the capillary, the microcirculation will be disrupted and ischemic occur. Normal myosit cells will be replaced by fibroblasts that tend to contract. Subjects and Method: A 10 years old boy had a traffic accident while riding a motorcycle 6 days before the patient came to the hospital. The patient could not walk, feeling pain and swelling on the left knee, the patient didn’t bring to the hospital immediately after the accident. On physical examination, there was angulation in the distal left femur, there was tenderness on palpation and unable to do dorsiflexion or moving the fingers of the left foot but still could feel touch stimu­la­tion on the pedis. Results: In our patient case with the diagnosis of left femoral artery occlusion et causa closed fracture distal femur (Salter-Harris type II) managed by surgery to release the femoral artery with internal fixation to the distal femur using Kirschner wire (minimally invasive) and massage to the femoral artery give optimal results. Conclusion: Surgery to release the femoral artery with internal fixation to the distal femur using Kirschner wire (minimally invasive) and massage to the femoral artery give an optimal result. Key w ords: Salter-Harris fracture, femoral artery, Kirschner wire, Volkmann's ischaemic contracture Correspondence: Pamudji Utomo. Department of Orthopaedics and Traumatology, Prof. Dr. R. Soeharso Orthopaedics Hospital. Email: utomodr@yahoo.com Indonesian Journal of Medicine (2019), 4(1): 75-81 https://doi.org/10.26911/theijmed.2019.04.01.12

Temporomandibular joint arthrocentesis: a technique proposal. Case report

ABSTRACT BACKGROUND AND OBJECTIVES: Arthrocentesis is an effective treatment to reduce or eliminate pain, increase maximal interincisal distance, and to eliminate joint effusion in patients with disc displacement without reduction. This study aims to expose and to discuss a new technique proposal of temporomandibular joint arthrocentesis applied in the treatment of a single case of disc displacement without reduction. CASE REPORT: Female patient, 18-year-old patient sought treatment due to joint pain and mouth opening limitation. The maximal interincisal distance was 30.28mm. Magnetic resonance imaging confirmed the diagnosis of disc displacement without reduction with signs of joint effusion in the right temporomandibular joint. Temporomandibular joint arthrocentesis was performed under selective sensory nerve block of the auriculotemporal, the masseteric and posterior deep temporal nerves. Two needles were inserted in the upper compartment of the temporomandibular joint. In the second needle, a transparent catheter was connected into a vacuum pump. Clinically, after the arthrocentesis, the maximal interincisal distance increased to 46.25mm, and the patient referred no more pain. After six months, a magnetic resonance imaging was performed to observe the results, and there were no more signs of joint effusion. CONCLUSION: Temporomandibular joint arthrocentesis was an effective treatment for this patient with disc displacement without reduction. The aspect of this technique that is particularly relevant for clinical practice was the connection of a transparent catheter to a vacuum pump. In fact, it allowed the visualization of the solution fluidity, as well as guides the flow of the solution used for joint washing, optimizing the irrigation. However, new studies are necessary to compare different protocols of irrigation with and without the associated use of a vacuum pump.

Microvascular Changes in Peripapillary and Optic Nerve Head Tissues After Trabeculectomy in Primary Open-Angle Glaucoma.

To determine microvasculature changes in the deep optic nerve head (ONH) and peripapillary tissues after trabeculectomy, and to correlate these with changes in the lamina cribrosa (LC) curvature. Fifty-six eyes with primary open-angle glaucoma that underwent trabeculectomy were included. The optic nerve and peripapillary microvasculature were evaluated in en face images obtained using optical coherence tomography (OCT) angiography (OCTA) before and 3 months after trabeculectomy. The OCTA-derived vessel density (VD) was calculated in each layer segmented into the prelaminar tissue (PLT), LC, peripapillary retina (PR), and peripapillary choroid (PPC). Swept-source OCT volume scanning of ONH was performed on the same day as OCTA to examine the change in LC curvature quantified as the LC curve index (LCCI). At 3 months postoperative, the IOP and LCCI had significantly decreased (both P < 0.001). OCTA images revealed a significant increase in VD in the LC (P = 0.006), but not in the PLT, PR, or PPC. Twenty-six eyes showed both significant LCCI decrease and VD increase based on 95% Bland-Altman limits of agreement. The VD increase in the LC was significantly associated with larger percentage reductions in IOP (P = 0.040) and LCCI (P < 0.001) in the univariate analysis. Multivariate analysis revealed that only the LCCI reduction was a significant factor affecting the VD increase in the LC. A significant increase in VD was observed at the level of the LC after trabeculectomy. The VD increase was more strongly associated with the reduction in the LC curvature than with the reduction of IOP.

An unusual presentation of eosinophilic granulomatosis with polyangiitis with a good response to rituximab

IntroductionEosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis that belongs to the anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides. It usually presents with late onset asthma in association with ear, nose and throat, cardiac, lung and gastrointestinal involvement. Aim of the workTo present a case of EGPA man with an unusual presentation. Case reportA 24 years old patient with EGPA presented with deep vein thrombosis and nerve palsy without a history of asthma or other usual manifestations of the disease. The left leg showed a skin rash and associated deep vein thrombosis as well as a small ulcer over the pulp of the right thumb. The total leucocyte count was 14.5 × 109/L (41% eosinophils), erythrocyte sedimentation rate was 30 mm/1st hour and C-reactive protein 12.2 mg/L. Hepatitis B and C serology, antinuclear antibody (ANA) and antiphospholipid antibodies were all negative. ANCA was positive: myeloperoxidase (MPO) 36.9 U/ml and proteinase-3 (PR3) 15.9 U/ml and urinalysis was normal. The dermal and subcutaneous blood vessels displayed fibrinoid deposits, necrosis, and neutrophilic infiltrates in keeping with vasculitis. The patient showed a prompt and good response to corticosteroid and rituximab therapy with resolution of his symptoms. ConclusionThere is a necessity to keep an open eye for the diagnosis of EGPA in patients with eosinophilia even in the absence of asthma or other usual manifestations, as prompt therapy may be organ and life-saving. B cell therapy should be considered in patients resistant to conventional therapy and those in whom preservation of fertility is desired.

Safety Profile and Short-term Outcomes of BST-CarGel as an Adjunct to Microfracture for the Treatment of Chondral Lesions of the Hip.

Background:Acetabular cartilage lesions are a common abnormality found in patients undergoing hip arthroscopic surgery and may cause pain and functional limitations. Several strategies have been developed to treat chondral defects, with no overwhelming success. Recently, BST-CarGel has gained interest as a scaffolding material that can be injected into the microfracture site to stabilize the clot and facilitate cartilage repair.Purpose:To perform a retrospective analysis of prospectively collected data to evaluate the safety profile and short-term clinical and radiographic outcomes of patients treated arthroscopically with BST-CarGel for acetabular chondral defects in conjunction with microfracture.Study Design:Case series; Level of evidence, 4.Methods:A retrospective chart review was performed on all patients who underwent hip arthroscopic surgery by the senior surgeon to identify those who had BST-CarGel applied to their hip from November 2014 to July 2016, and basic demographic information for those patients was obtained. Operative reports and patient charts were reviewed to assess intraoperative and postoperative complications as well as to obtain the details of surgery, including lesion size and treatment method of the labrum (repair vs reconstruction). All patients filled out self-reported questionnaires, including the international Hip Outcome Tool (iHOT), Hip Outcome Score–Activities of Daily Living (HOS-ADL), and Hip Outcome Score–Sports Profile (HOS-SP) at the time of consultation and at 1 year postoperatively, and results were used to assess the clinical outcomes of surgery.Results:Thirty-seven patients (37 hips) with a mean age of 36.19 years at the time of the index procedure were evaluated. There were 30 male patients, and 20 procedures were performed on the right hip. The minimum follow-up was 1 year, with a mean follow-up of 12.72 months. There were no major adverse events of deep vein thrombosis, blood vessel or nerve damage, hemarthrosis, arthralgia, or device-related adverse events. Two patients (5.4%) were readmitted because of pain, probably resulting from an inflammatory reaction to BST-CarGel. At 1 year postoperatively, there were statistically significant improvements in the iHOT (40.4 to 59.1; P < .001), HOS-ADL (60.6 to 71.4; P = .02), and HOS-SP (36.9 to 51.6; P = .01) scores. When the patients were subdivided based on the chondral defect size, the iHOT score improved for all chondral defect sizes, and the HOS-SP score improved in patients with medium (2-4 cm2) and very large (>6 cm2) chondral defects. In addition, the iHOT score improved whether the patients had their labrum repaired or reconstructed (P < .001 and P = .02, respectively).Conclusion:The arthroscopic treatment of chondral acetabular defects with BST-CarGel demonstrates a satisfactory safety profile, with statistically significant improvement in patient-reported clinical outcome scores, even for those with very large chondral defect sizes.

Deep Optic Nerve Head Morphology Is Associated With Pattern of Glaucomatous Visual Field Defect in Open-Angle Glaucoma.

We investigated the relationship between visual field (VF) defect pattern and deep optic nerve head (ONH) morphology in open angle glaucoma (OAG) eyes using spectral-domain optical coherence tomography (SD-OCT). Of 278 OAG eyes, 169 with and 55 without externally oblique border tissue (EOBT) were included in the final analysis. Enhance depth imaging SD-OCT was used to measure the deep ONH parameters, such as EOBT length, ONH tilt angle, and optic canal (OC) obliqueness. The extents and locations of the maximum deep ONH parameters were explored according to VF pattern in OAG eyes. OAG eyes with EOBT showed longer axial length (AL; 25.6 vs. 24.4 mm; P < 0.001) and greater superior VF defects (67.5% vs. 49.1%; P = 0.02) compared to OAG eyes without EOBT. Multivariate logistic regression analysis revealed that relatively inferior location of maximum deep ONH parameters was associated with superior hemifield defects dominant in OAG (P < 0.001 in all parameters). In addition, the locations of maximum deep ONH parameters were consistent with dominant VF defect locations in OAG eyes with AL < 24.5 mm. The presence of paracentral scotoma in OAG was associated with worse mean deviation (MD) and relatively inferior location of deep ONH parameters. The locations of maximum deep ONH parameters were associated with the location of dominant VF defects and presence of paracentral scotoma in OAG eyes.

Neurostimulation

Neurostimulation modalities in psychiatric practice and research efforts use magnetic and electric fields to modulate neuronal functioning. Physicians have used these modalities since ancient history, but most modern brain stimulation treatments developed after the inception electroconvulsive therapy in 1937. Noninvasive brain stimulation generally refers to treatments that do not require surgery, such as electroconvulsive therapy, repetitive transcranial magnetic stimulation, and transcranial current stimulation. Conversely, deep brain stimulation and vagal nerve stimulation are the two most researched invasive brain stimulation modalities for psychiatric disorders. Treatment with repetitive transcranial magnetic stimulation has been shown to be effective for the treatment of resistant major depressive disorders but is less rapid acting and may be optimal for a different patient population as compared to electroconvulsive therapy. Research focused on transcranial direct current stimulation continues to expand, but its role in clinical psychiatric practice is currently not well defined. Despite mixed and, in some cases, disappointing results, invasive brain stimulation techniques such as deep brain stimulation and vagal nerve stimulation will likely continue to have an important role for certain treatment-resistant populations in psychiatric practice. This review examines the development, basic physiologic mechanisms, and evidence base of neurostimulation modalities in psychiatry. This review contains 4 figures, 6 tables and 38 references Key Words: deep brain stimulation, invasive, neurostimulation, noninvasive, transcranial direct current stimulation, transcranial electrical stimulation, transcranial magnetic stimulation, treatment-resistant depression, vagal nerve stimulation

Superior gluteal nerve: a new block on the block?

The superior gluteal nerve is responsible for innervating the gluteus medius, gluteus minimus and tensor fascia latae muscles, all of which can be injured during surgical procedures. We describe an ultrasound-guided approach to block the superior gluteal nerve which allowed us to provide efficient analgesia and anesthesia for two orthopedic procedures, in a patient who had significant risk factors for neuraxial techniques and deep peripheral nerve blocks. An 84-year-old female whose regular use of clopidogrel contraindicated neuraxial techniques or deep peripheral nerve blocks presented for urgent bipolar hemiarthroplasty in our hospital. Taking into consideration the surgical approach chosen by the orthopedic team, we set to use a combination of general anesthesia and superficial peripheral nerve blocks (femoral, lateral cutaneous of thigh and superior gluteal nerve) for the procedure. A month and a half post-discharge the patient was re-admitted for debriding and correction of suture dehiscence; we performed the same blocks and light sedation. She remained comfortable in both cases, and reported no pain in the post-operative period. Deep understanding of anatomy and innervation empowers anesthesiologists to solve potentially complex cases with safer, albeit creative, approaches. The relevance of this block in this case arises from its innervation of the gluteus medius muscle and posterolateral portion of the hip joint. To the best of our knowledge, this is the first report of an ultrasound-guided superior gluteal nerve block with an analgesic and anesthetic goal, which was successfully achieved.

Spectrally distinct channelrhodopsins for two-colour optogenetic peripheral nerve stimulation.

Technologies for peripheral nerve stimulation have conventionally relied on the anatomic placement of electrodes adjacent to subsets of sensory fibres or motor fibres that selectively target an end effector. Here, we demonstrate the use of optogenetics to directly target the innervating fibres of an end effector by relying on retrograde transfection of adeno-associated virus serotype 6 to restrict axonal opsin expression to the desired fibre targets. By using an in vivo screen in rats, we identify the first channelrhodopsins as well as a halorhodopsin that respond to red light in the peripheral nerve. Combining two channelrhodopsins with spectrally distinct activation profiles allowed us to drive opposing muscle activity via two-colour illumination of the same mixed nerve. We also show halorhodopsin-mediated reductions in electrically evoked muscle tremor spectrally optimized for deep peripheral nerves. Our non-invasive peripheral neurostimulator with targeted multi-fascicle resolution enables scientific and clinical exploration, such as motor control in paralysis, biomimetic sensation feedback for amputees and targeted inhibition of muscle tremor.

Selective decline in the prevalence of slowly adapting type I mechanoreceptors during development

Merkel nerve endings are identified physiologically as slowly adapting type I mechanoreceptor units. They are important for fine acuity tactile perception. We examined the effect of age on the electrophysiological availability of different types of slowly adapting mechanoreceptor units. Using 6–50 week old rats, we observed an obvious decline with age in the probability of recording from St I units of the deep vibrissal nerve. The precipitous decline occurred between ages 6–14 weeks and then stabilized. By contrast, the prevalence of St II units, the other type of slowly adapting mechanoreceptor, remained constant over the age range studied. These observations correlate with anatomical findings reported elsewhere.

Nerve Growth Factor Is Associated With Sexual Pain in Women With Endometriosis.

Endometriosis is present in 1 in 10 reproductive-age women, and half experience deep dyspareunia (pelvic pain with sexual intercourse). Our objective was to investigate nerve growth factor (NGF) and its receptors (TrkA/p75NTR) in endometriosis-associated deep dyspareunia. A total of 32 women with endometriosis in the posterior pelvic compartment (cul-de-sac/uterosacrals) were included, either with (n = 17) or without (n = 15) deep dyspareunia symptoms confirmed by endovaginal ultrasound-assisted palpation on examination. Expression of NGF, TrkA, and p75NTR in the surgically excised cul-de-sac/uterosacral endometriosis was examined by immunohistochemistry and Histoscore blinded to pain phenotypes. Additionally, endometriotic stromal cells (ESCs; n = 3) from ectopic endometriosis lesions were cultured and incubated with/without NGF and/or Trk inhibitor K252a, followed by expression analysis of prostaglandin-endoperoxide synthase 2 (PTGS-2)/cyclooxygenase 2 (COX-2; reverse transcription quantitative real-time polymerase chain reaction and Western blot) and prostaglandin E2 (PGE2) secretion (enzyme-linked immunosorbent assay). We found that the immunointensity of NGF and TrkA, but not p75NTR, was significantly elevated in endometriotic stroma and epithelium from women with deep dyspareunia compared to women without deep dyspareunia. Nerve growth factor immunoreactivity in the stroma was also significantly associated with deep dyspareunia intensity and local nerve bundle density. In cultured ESCs, NGF significantly increased PTGS-2/COX-2 mRNA and protein levels as well as PGE2 secretion, and these effects could be abolished by pretreatment of Trk inhibitor K252a. In conclusion, elevated NGF levels were associated with deep dyspareunia in women with cul-de-sac/uterosacral endometriosis. This association may be mediated by increased nerve bundle density and by COX-2/PGE2 stimulation via Trk receptor. Nerve growth factor signaling may play an important role in endometriosis-associated sexual pain.

Positional Change of Optic Nerve Head Vasculature during Axial Elongation as Evidence of Lamina Cribrosa Shifting: Boramae Myopia Cohort Study Report 2

To investigate the positional change of central retinal vasculature and vascular trunk to deduce the change in the lamina cribrosa (LC) during axial elongation. Prospective cohort study. Twenty-three healthy myopic children (46 eyes). Participants had undergone a full ophthalmologic examination and axial length measurement every 6 months for 2 years. Using spectral-domain OCT, circle scans centered around the optic disc in the glaucoma progression analysis mode, which enabled capturing of the same positions throughout the entire study period, and enhanced depth imaging of the deep optic nerve head complex were performed. Infrared imaging of the circle scans was used to measure the changes in the angles between the first and final visits. The angle between the major superior and inferior retinal arteries was measured along the circle scan twice: from the center of the circle scan and from the central retinal vascular trunk, respectively. The positional change of the retinal vascular trunk also was measured. Change in vascular angle and position of vascular trunk with axial elongation and associated factors. The vascular angle measured from the center of the circle scan did not change (P= 0.247), whereas the angle measured from the central retinal arterial trunk decreased with axial elongation (P < 0.001). A generalized estimating equation analysis revealed that the factors associated with angle decrease were axial elongation (P= 0.004) and vascular trunk dragging (P < 0.001). The extent of vascular trunk dragging was associated with axial elongation (P < 0.001) and increased border length with marginal significance (P= 0.053), but the extent of dragging could not be explained fully by their combination. The major directionality of dragging was mostly to the nasal side of the optic disc, with large variations among participants. During axial elongation, the retinal vasculature at the posterior pole was unchanged, whereas the position of the central vascular trunk was dragged nasally. Because the central retinal vascular trunk is embedded in the LC, its dragging indicates nasal shifting of the LC, which could explain the vulnerability of myopic eyes to glaucomatous optic neuropathy.

Mechano- and thermosensitivity of injured muscle afferents 20 to 80 days after nerve injury.

Chronic injury of limb nerves leading to neuropathic pain affects deep somatic nerves. Here the functional properties of injured afferent fibers in the lateral gastrocnemius-soleus nerve were investigated 20 and 80 days after suturing the central stump of this muscle nerve to the distal stump of the sural nerve in anesthetized rats. Neurophysiological recordings were made from afferent axons identified in either the sciatic nerve (87 A-, 63 C-fibers) or the dorsal root L4/L5 (52 A-, 26 C-fibers) by electrical stimulation of the injured nerve. About 70% of the functionally identified A-fibers had regenerated into skin by 80 days after nerve suture; the remaining A-fibers could be activated only from the injured nerve. In contrast, 93% of the functionally identified C-fibers could only be activated from the injured sural nerve after 80 days. Nearly half of the injured A- (45%) and C-fibers (44%) exhibited ongoing and/or mechanically or thermally evoked activity. Because ~50% of the A- and C-fibers are somatomotor or sympathetic postganglionic axons, respectively, probably all injured muscle afferent A- and C-fibers developed ectopic activity. Ongoing activity was present in 17% of the A- and 46% of the C-fibers. Mechanosensitivity was present in most injured A- (99%) and C-fibers (85%), whereas thermosensitivity was more common in C-fibers (cold 46%, heat 47%) than in A-fibers (cold 18%, heat 12%). Practically all thermosensitive A-fibers and C-fibers were also mechanosensitive. Thus, unlike cutaneous axons, almost all A- and C-fibers afferents in injured muscle nerves demonstrate ectopic activity, even chronically after nerve injury. NEW & NOTEWORTHY After chronic injury of a muscle nerve, allowing the nerve fibers to regenerate to the target tissue, 1) most afferent A-fibers are mechanosensitive and regenerate to the target tissue; 2) ectopic ongoing activity, cold sensitivity, and heat sensitivity significantly decrease with time after injury in A-afferents; 3) most afferent C-fibers do not regenerate to the target tissue; and 4) injured C-afferents maintain the patterns of ectopic discharge properties they already show soon after nerve injury.

Modulation of Neurally Mediated Vasodepression and Bradycardia by Electroacupuncture through Opioids in Nucleus Tractus Solitarius

Stimulation of vagal afferent endings with intravenous phenylbiguanide (PBG) causes both bradycardia and vasodepression, simulating neurally mediated syncope. Activation of µ-opioid receptors in the nucleus tractus solitarius (NTS) increases blood pressure. Electroacupuncture (EA) stimulation of somatosensory nerves underneath acupoints P5–6, ST36–37, LI6–7 or G37–39 selectively but differentially modulates sympathoexcitatory responses. We therefore hypothesized that EA-stimulation at P5–6 or ST36–37, but not LI6–7 or G37–39 acupoints, inhibits the bradycardia and vasodepression through a µ-opioid receptor mechanism in the NTS. We observed that stimulation at acupoints P5–6 and ST36–37 overlying the deep somatosensory nerves and LI6–7 and G37–39 overlying cutaneous nerves differentially evoked NTS neural activity in anesthetized and ventilated animals. Thirty-min of EA-stimulation at P5–6 or ST36–37 reduced the depressor and bradycardia responses to PBG while EA at LI6–7 or G37–39 did not. Congruent with the hemodynamic responses, EA at P5–6 and ST36–37, but not at LI6–7 and G37–39, reduced vagally evoked activity of cardiovascular NTS cells. Finally, opioid receptor blockade in the NTS with naloxone or a specific μ-receptor antagonist reversed P5–6 EA-inhibition of the depressor, bradycardia and vagally evoked NTS activity. These data suggest that point specific EA stimulation inhibits PBG-induced vasodepression and bradycardia responses through a μ-opioid mechanism in the NTS.

Early Corneal Innervation and Trigeminal Alterations in Parkinson Disease: A Pilot Study.

To describe corneal innervation and trigeminal alterations in drug-naive patients with Parkinson disease (PD). A case series study was conducted by recruiting 3 early drug-naive patients with PD, 2 men and 1 woman (age: 72, 68, and 66, respectively). Ophthalmologic assessment included Ocular Surface Disease Index questionnaire, visual acuity by the logarithm of the minimum angle of resolution score, pupillary light reflexes, extrinsic ocular movements, corneal sensitivity, and slit-lamp examination. Corneal innervation parameter changes were evaluated in vivo using the Confoscan 4 confocal microscope, and they were compared with a control data set. The Heidelberg Retina Tomograph 3 (HRT3) has been used to assess retinal alterations in our patients, if compared with normal range values provided by the HRT3. Moreover, 3T magnetic resonance imaging (MRI) analysis of water diffusion property changes of trigeminal nerves was performed. All data were analyzed and compared with 2 control data sets made by 14 age-matched controls. Patients with PD showed profound alterations of corneal innervation and of trigeminal diffusion MRI parameters, compared with controls. Strong differences (PD vs. controls) were found for deep nerve tortuosity (Kallinikos mean 19.94 vs. 2.13) and the number of beadings (mean 34.2 vs. 15.5). HRT3 retinal evaluation revealed less structural changes compared with the normal range. Diffusion MRI showed profound changes of white matter diffusion properties (PD vs. controls), with fractional anisotropy decrement (mean 0.3029 vs. 0.3329) and mean diffusivity increment (mean 0.00127 vs. 0.00106). Corneal innervation changes might occur earlier in patients with PD than in retinal ones. Confocal corneal innervation analysis might provide possible early biomarkers for a better PD evaluation and for its earlier diagnosis.

Comparison between ropivacaine and bupivacaine in deep topical fornix nerve block anesthesia in patients undergoing cataract surgery by phacoemulsification.

Purpose:In this study, we intend to analyze ropivacaine and bupivacaine in various parameters during phacoemulsification under deep topical fornix nerve block (DTFNB), a known form of nerve block for phacoemulsification.Methods:This prospective randomized study was conducted on 100 patients undergoing elective cataract surgery by phacoemulsification under DTFNB. Patients were divided into two equal groups of fifty patients each, Groups B (bupivacaine) and Group R (ropivacaine). Two sponges, approximately 2 mm × 3 mm dimensions, saturated with either 0.5% bupivacaine or 0.75% ropivacaine were placed deep in the conjunctival fornices to perform the deep topical block. Both groups were evaluated for magnitude of pain and discomfort at various stages of phacoemulsification using a simple pain scoring system. The level of surgeon satisfaction, requirement for supplementary anesthesia, and surgical complications were also evaluated. Quantitative variables between the two groups were compared using unpaired t-test. Qualitative variables were correlated using Chi-square test.Results:Overall demographic parameters of patients were similar in both groups. Similar mean pain scores were found in the ropivacaine and bupivacaine groups, with no statistical significance. Surgical satisfaction and the need for supplemental anesthesia were also statistically insignificant.Conclusion:Ropivacaine is a good alternative for deep topical anesthesia as it has a better safety margin and lesser toxic effect than other comparable local anesthetic agents.

Lamina Cribrosa Changes after LaserIn SituKeratomileusis in Myopic Eyes

PurposeTo determine deep optic nerve head structure changes after transient intraocular pressure elevation during laser in situ keratomileusis (LASIK) for myopia.MethodsEnhanced depth imaging-optical coherence tomography was performed in each myopic eye that underwent LASIK surgery. Enhanced depth imaging-optical coherence tomography images were created at postoperative 1 day, 1 week, 2 weeks, and 1 month. Lamina cribrosa (LC) thickness, LC depth and prelaminar thickness at the superior, middle and inferior portions of the optic nerve head were measured by two investigators.ResultsForty eyes in 40 patients were included in the present study. During follow-up, there were no significant differences in prelaminar thickness or LC depth. The LC demonstrated increased thickness at postoperative 1 day at all three locations (superior, middle, and inferior) (p < 0.001, p < 0.001, p < 0.001, respectively). However, no significant changes were observed at postoperative 1 week, 2 weeks, and 1 month.ConclusionsThe LC thickness could increase at 1 day after LASIK surgery. However, the thickness will gradually return to baseline morphology. Temporary intraocular pressure increase during LASIK does not appear to induce irreversible LC thickness changes.

Efficacy of the twin block, a peripheral nerve block for the management of chronic masticatory myofascial pain: A case series.

Masticatory myofascial pain is the one of the most common etiologies for nonodontogenic pain, often characterized by the presence of trigger points. Conventional management includes approaches such as jaw exercises, physical therapy, intraoral appliances, medications, and trigger point injections. Peripheral/regional nerve blocks have shown to be effective in managing myogenous pain conditions. The twin block is a nerve block that blocks both the masseteric and the anterior deep temporal nerves. The objective of this case series is to illustrate expeditious and sustained efficacy of the twin block in the management of chronic masticatory myofascial pain.